In Coding
Oct 7th, 2019
Don’t let insufficient documentation lead you astray. How many times has a provider asked you, “What do I need to document to get a 99215?” All too often, medical coders feel they should help their providers understand what elements of documentation are needed to warrant the higher level evaluation and management (E/M) service. Do not ...
In CMS
Sep 19th, 2019
Proactive rule seeks to curb fraud and abuse against vitally important federal health care programs. The Centers for Medicare & Medicaid Services (CMS) issued a final rule earlier this month that strengthens their ability to stop fraud before it happens by keeping unscrupulous providers out of our federal health insurance programs. This first-of-its-kind action changes ...
In Billing
Aug 29th, 2019
A physician assistant (PA) serves as an assistant surgeon only to suture and close an incision. There is no documentation that the PA performed any other function to assist the primary surgeon during the surgery performed on the Medicare patient, such as providing extra hands needed for tasks which required more than the surgeon’s two ...
Implement an enforceable assignment of benefits and protocols to protect providers against insurance underpayment and patient theft. Most members and contracted providers expect and/or take for granted Employee Retirement Income Security Act (ERISA) of 1974 law and assignment of benefits (AOB). But for non-participating (non-par) providers, the ability to receive insurance reimbursement directly, g...
In Billing
Aug 9th, 2019
January 1, 2020, marks the start of the Appropriate Use Criteria (AUC) program educational and operations testing period, at which time Medicare Administrative Contractors (MACs) will begin accepting AUC-related modifiers on claims for advanced diagnostic imaging services furnished to Medicare Part B patients. The voluntary participation period ends December 31, 2019. Know AUC Program Requirements ...